| NPI | 1023008703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4857) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D5433) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2013-04-15 |